Background: An important mission of the NIH is to prevent premature cardiovascular deaths of Americans, yet it remains unknown why some hospitals have good survival rates after cardiac arrest while other hospital survival rates remain worrisome. In-hospital cardiac arrest (IHCA) represents a significant burden as an estimated 200,000 arrests occur in hospitalized patients in the United States annually. Of concern, outcomes are poor and survival rates after IHCA vary significantly, from 1-40% across hospitals. This variability among hospitals suggests an opportunity to improve care and survival rates of hospitalized patients if we can better understand the factors that critically impact prognosis. Objective: The focus of this proposal is to identify hospitals with high and low in-hospital arrest survival rates and the factors which most closely predict IHCA outcomes. Study design and Methods: The specific aims for this proposal are: Aim 1: Develop a patient level model of risk-adjusted IHCA survival rates Approach: Conduct a retrospective multicenter cohort study using data from an existing registry to calculate IHCA risk-adjusted survival rates. Aim 2: Identify measurable hospital predictors of IHCA survival rates Approach: Develop a hierarchical regression model of IHCA outcomes with patient and hospital level variables. Then, use risk-adjusted survival rates to stratify hospitals by high and low IHCA outcomes. Aim 3: Survey key informants from a registry of hospitals to determine how process measures for cardiac arrest management are associated with IHCA survival rates. Approach: Conduct a literature review and semi-structured interviews to inform the development of a survey. Administer the survey to a subset of resuscitation code committee directors (at hospitals with high and low IHCA survival rates) and analyze the survey data to assess how IHCA process measures are associated with outcomes. Long term objective: This project will lay the groundwork for future studies geared towards development, validation, and implementation of patient-oriented performance measures for IHCA care. These performance measures will have significant relevance for patients evaluating hospitals, hospital administrators developing patient safety and quality improvement initiatives, and policy makers involved in public reporting.